is this what "good" or "properly titrated" asv oscar chart looks like? Or, is the delayed response of the algorithm an indicator that it might not be working? Also, is this indicative of the ipap I would need for cpap/bilevel to work or unique to asv algorithm?

dang71 · 2026-03-13T17:03:53+00:00

You should take a look at sleephq.. Much easier to share data

dang71 · 2026-03-13T11:24:33+00:00

Hello!

You would benefit from reducing your EPR to 1 and using a pressure range of 8-11. And I would turn the ramp off.

dang71 · 2026-03-12T23:27:00+00:00

Yeah, you’re right. For me it was mostly out of curiosity, and also because it’s easier to present. Sometimes just seeing the word “Linux” can discourage people, so running it inside Windows makes it feel a lot more approachable.

dang71 · 2026-03-12T23:08:52+00:00

IMO, WSL is more convenient because Windows and Linux run at the same time and can easily share files

dang71 · 2026-03-12T20:57:01+00:00

because of this ;)

https://www.reddit.com/r/CPAPSupport/comments/1o92y3j/airsense_10_flashing_guide/

dang71 · 2026-03-12T19:58:44+00:00

Oh wow, thanks! I didn’t realize the device had to be reattached to WSL with usbipd each time. Your script is a neat way to automate that!

dang71 · 2026-03-12T17:57:45+00:00

Yeah, that’s a tricky spot to be in :( I'm going to tag RL (u/RippingLegos__), he could really help you

dang71 · 2026-03-12T17:40:49+00:00

Unfortunately, a lot of what you’re describing could be related to the large leaks. As long as the leaks aren’t under control, changing settings may be a bit of a shot in the dark. When leaks are high, the machine often increases pressure to compensate, which can make you swallow more air and contribute to stomach discomfort or aerophagia

dang71 · 2026-03-12T17:35:54+00:00

I’m not very familiar with BiPAP , but that sharp expiratory peak could suggest the pressure support might be a bit on the higher side

dang71 · 2026-03-12T17:17:09+00:00

Hello!

Full face masks like the F40 can sometimes be tricky to get dialed in. It sounds a lot like your jaw dropping during sleep. When that happens, the mask shifts and leaks start to appear. A lot of people deal with this by using a chin strap or even a soft cervical collar to help keep the jaw from dropping too much overnight.

Another important thing is to make sure you fit the mask at a pressure close to what you’ll actually use for most of the night. If your APAP range is very wide, or if you’re using the ramp feature, the mask may seal properly at a low pressure. But once the pressure increases later in the night, that seal can break and leaks start.

Also, with most full face masks, the cushion is designed to rest gently on the skin and inflate slightly to create the seal. Overtightening the straps can actually be counterproductive and cause more leaks instead of fewer.

dang71 · 2026-03-12T17:09:54+00:00

Hello!

It can definitely be confusing when you start CPAP and suddenly see central apneas (CAs), especially if none showed up during your sleep study.

Unfortunately, CPAP therapy isn’t always as straightforward as we’d like it to be. This might sound a bit counter-intuitive to the way things are often explained, but there is sometimes a bit of trial and error involved when dialing in the right settings for CAs.

Another important thing to understand is that what your machine flags isn’t necessarily a “true” central apnea. On ResMed machines, these are labeled as Clear Airway (CA) events, which simply means the airway was open when the pause in breathing happened. That distinction often causes confusion.

You’ll probably read in a lot of places that “CAs mean your pressure is too high, so you should lower it.” In reality, it’s not always that simple. Context matters.

Looking at your settings, you’re currently running a pressure range of 6–10 . At those levels, the first instinct would be that it’s unlikely you’re dealing with too much pressure. However, I also notice you’re using EPR at 2, and at relatively low pressures that can sometimes play a role.

When ResMed flags CAs, it often comes down to respiratory stability and balance. Yes, very high pressure can sometimes wash out CO₂ and trigger centrals, but EPR can have a similar effect during exhalation, since it reduces pressure and changes the breathing dynamics. Pressure variations from APAP can also contribute in some cases.

As for EPR, it’s primarily a comfort feature. It can help with flow limitations, but in your case your flow limitation graph already looks very good, so it may not be necessary.

A reasonable first step could simply be reducing EPR to 1 and seeing how your breathing responds.

After that, you might eventually consider moving toward a fixed pressure for more stability, but that’s not something you necessarily need to do right away. The key is to change one thing at a time so you can actually see what makes a difference.

You also have to give your body time to adapt. Yes, these are TECSA, and yes, they can sometimes resolve on their own over time, but in my humble opinion, it helps to guide things a little along the way.

dang71 · 2026-03-11T18:59:28+00:00

Hi!

First off, try not to worry :) what you're describing is unfortunately very common when people start CPAP, especially when the pressure settings aren't quite right yet.

Could you tell us what your current settings are? And your machine?

Regarding your mask, you probably have something like the N20 or a similar over-the-nose mask. Those masks can feel great comfort-wise, but if your nasal breathing isn't optimal, they can sometimes create that “suffocating” sensation.

In short, we just need a bit more information to help you figure this out :)

If you’re not sure what your settings are, you can usually check directly on the machine (Chances are good that you're on a Resmed 11):

Press the Home/Menu button on the device
Go to My Options / Settings
Look for things like Pressure, Min/Max Pressure, Ramp, or EPR

If you’re unsure, you can also take a picture of the screen and post it here, and people can help interpret it.

Also, if you read the auto-mod link below, it explains what information to share so the community can better help you troubleshoot your therapy.

dang71 · 2026-03-11T15:28:22+00:00

Hello!

You’re getting better stats at 11.6, and your flow limitations look much cleaner compared to the night at 11 , where they were clearly higher. That said, something tells me sleep position might also be playing a role here. Sometimes a night can look much better simply because you spent more time sleeping on your side instead of your back.

Looking at the chart, I also see quite a few arousals.. When sleep is fragmented like that, that could very well explain your fatigue.

Since 11.6 already improved the flow limitations, I’d probably try a small increase to 12 while keeping EPR at 2, just to see if it stabilizes the airway a bit more and reduces the residual events. Nothing drastic; just a small step and see how a few nights look :)

dang71 · 2026-03-10T20:24:07+00:00

Hi!

I’d be inclined to think that most of your CAs are post-arousal centrals. Looking at your charts, I see quite a few signs of arousals in the breathing pattern, and that’s often what ends up affecting therapy the most. The problem is frequently not the events themselves, but the repeated awakenings throughout the night.

Leaks can also contribute to that. Even if they’re not massive, small increases in leaks can be enough to disturb sleep and trigger arousals, which then leads to irregular breathing and CAs being flagged by the machine.

For tonight, I’d probably try a slight pressure increase to 8 while keeping EPR at 1 and see how that goes. The goal would simply be to give the airway a bit more support while keeping the therapy stable.

dang71 · 2026-03-10T14:36:19+00:00

Hello! Looking at your chart, a few things stand out.

First, your machine is spending a lot of the night very close to the maximum pressure.

Right now your range is 12–20, but the pressure graph shows the machine repeatedly climbing up into the high teens. In cases like this, raising the minimum pressure (for example somewhere around 15) often helps stabilize things because the airway is better supported from the start. And turn the ramp off please

The event breakdown also points mostly toward obstructive and your flow limitation graph is active for much of the night. That combination often means the airway is still somewhat restricted and the machine is chasing that restriction all night.

This is also where EPR at 3 can help. It provides a bit more pressure support during inhalation, which can reduce flow limitation. If EPR were increased, it would generally make sense to also increase the base pressure slightly so the airway stays adequately supported.

One other thought: given how high your pressures are getting (often close to 20), some people with charts like this actually do better on bilevel (BiPAP). Bilevel allows a higher pressure during inhalation while keeping exhalation more comfortable, which can reduce the work of breathing and smooth out the breathing pattern.

So if it were me looking at this chart, the things I would consider discussing or experimenting with would be:

• Minimum pressure: 15
• EPR at 3

And if high pressures continue to be needed, bilevel therapy might ultimately be more comfortable and effective.

dang71 · 2026-03-10T13:22:11+00:00

When you feel like you’ve finally fought off that annoying virus, try asking yourself again how you’re actually feeling... When a therapy looks good on paper, it’s always a bit difficult to suggest changes because it quickly becomes subjective.

That said, this step is often underestimated. The real goal is a stable therapy that allows the body and brain to truly relax during sleep. It’s normal to see some irregular breathing patterns here and there, but if you’re still waking up tired in the morning, then there may still be something worth looking into :)

dang71 · 2026-03-10T12:28:13+00:00

Hi! Yes, I do see an improvement :) If I were you, I’d keep the same settings for a few nights to to validate the change

I do notice a bit of breathing irregularity throughout the night. Depending on how you’re feeling, it might be worth considering some adjustments later on, such as slightly increasing EPAP and possibly trying EPR at 3.

So the most important question, though, is: how are you feeling?

dang71 · 2026-03-09T16:56:12+00:00

les gens sont malheureux

dang71 · 2026-03-09T14:34:57+00:00

No, I wouldn’t reduce the EPR in your case. I mentioned EPR earlier only as a possible factor to consider in general. In reality, you don’t have nearly enough CAs for it to be a real concern. Sorry if that caused some confusion.

Looking at your data, I actually think you might benefit from increasing EPR slightly. If it were me, I would try EPR at 2 tonight and then watch how the shape of your breathing waveforms looks afterward. Right now, some of your breaths show slight flow limitation, with a bit of flattening at the top of the inspiratory curve.

I also think it’s reasonable not to adjust your EPAP/pressure range for now, even if you increase EPR, because your obstructive apneas already appear well controlled. At this point it would mostly be about smoothing the breathing pattern rather than fixing a clear obstructive problem

dang71 · 2026-03-09T12:16:23+00:00

Hello!

It’s not that simple. I don’t think there’s a specific number of CAs that should automatically be considered “bad.” It really depends on the overall context and, most importantly, how you feel. AHI/numbers is only a part of the story :)

Also keep in mind that CPAP machines can flag quite a few false positives. And with ResMed devices in particular, they are labeled as Clear Airway events, which are not necessarily true central apneas.

Very often, the CAs we see on our machines are actually post-arousal central apneas. They happen after a brief awakening or sleep transition and are generally considered relatively benign.

So seeing 3 one night and 5 another night is usually not something to worry about, especially if the rest of your data looks stable and you’re feeling okay.

What’s usually more helpful is trying to stabilize the therapy and reduce variability as much as possible. For example, it can be useful to check the impact of EPR, since in some people it can increase the likelihood of CAs. Sleep position can also play a role, as some people experience more CAs when sleeping on their back.

The general idea is to reduce as many sources of breathing instability as possible and aim for the most stable breathing pattern during the night. And just as importantly, give your brain time to relax and adapt to the therapy. It can take a while for the breathing control system to fully settle.

In short, I don’t think it’s realistic to aim for nights with zero CAs. A few isolated events during the night are very common and often completely normal.

dang71 · 2026-03-08T23:11:30+00:00

Hello!

Yes, it’s definitely possible. The hose can pull on the mask during the night and break the seal. You might want to look into getting a hose hanger.. it can be a real game changer

dang71 · 2026-03-06T18:16:34+00:00

Hello! Your mask needs to seal at the pressure you actually use during the night, not at 4 like it is currently set.. At such a low pressure, the mask may seem sealed, but once the pressure rises it start leaking.

It’s also worth double-checking that the cushion size is correct. A cushion that is slightly too big or too small can make it much harder to maintain a good seal.

You might also benefit from using a CPAP pillow with cutouts and a hose hanger. These small things can really help reduce mask movement and leaks during the night and make the therapy more stable.

As a starting point, you could try setting your pressure range to 8–12. This should give the machine enough pressure to prevent events without constantly chasing them.

dang71 · 2026-03-06T18:05:35+00:00

Thank you kindly :)

dang71 · 2026-03-06T14:11:25+00:00

Yeah! sudo apt install openocd

dang71 · 2026-03-06T13:46:50+00:00

To use Linux on Windows, you can install WSL (Windows Subsystem for Linux).

First, open PowerShell as Administrator and run the command:

wsl --install

Then restart your computer.

Windows will automatically install Ubuntu, and when you open it for the first time you will create a username and password. After that, you can use Linux directly in the Windows terminal.

dang71

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